[Arterial hypertension, vascular remodelling and atherosclerosis]

Therapy of essential hypertension (HT) should not imply the simple lowering of blood pressure alone but also reduction of the trophic effects provoked on the vascular system. Regression of left ventricular hypertrophy must be combined with "remodelling" of the overall arterial network to adapt to the abnormal physical forces acting on the vascular wall. This adaptive process has both qualitative and functional effects with structural modifications of the large arterial trunks as well as the smaller arteries, provoking adverse effects once they increase vascular resistance and diminish large artery compliance. Additionally, they tend to induce chronicity of HT, particularly since at the crossroad of these pathologic processes exist anomalies of endothelial secretory function. Treatment of HT should therefore comprise care of the vascular system, inasmuch as common mechanisms of cellular hypertrophy and proliferation are found in uncomplicated hypertension and atherosclerosis.